Provider Demographics
NPI:1164651550
Name:RYAN D. BLISSETT, D.M.D., P.C.
Entity Type:Organization
Organization Name:RYAN D. BLISSETT, D.M.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROSTHODONTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:BLISSETT
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:617-738-1950
Mailing Address - Street 1:60 JOY ST
Mailing Address - Street 2:#204
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02114-4008
Mailing Address - Country:US
Mailing Address - Phone:857-753-4114
Mailing Address - Fax:
Practice Address - Street 1:1540 BEACON ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-2215
Practice Address - Country:US
Practice Address - Phone:617-738-1950
Practice Address - Fax:617-734-0673
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-07
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA21630261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental